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Diabetic nephropathy
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Diabetic nephropathy

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Contributors: Shea A. Nagle BA, Michael W. Winter MD
Other Resources UpToDate PubMed

Synopsis

Diabetic nephropathy is a progressive kidney disease caused by vascular damage to the glomerular capillaries and arterioles as a consequence of long-standing hyperglycemia. Classically, this is characterized by progressive proteinuria followed by renal insufficiency. It can eventually lead to end-stage renal disease.

Patients with type 1 diabetes mellitus generally develop diabetic kidney disease within 10 years after diagnosis. There is more variability with diagnosis in patients with type 2 diabetes, as some people may never be affected and others lose renal function very quickly after diagnosis. Diabetic nephropathy is more common and more severe in African American and Latino populations. Aging, obesity, smoking, and poorly controlled hypertension are also risk factors for this condition.

Many physiologic factors are involved in the pathogenesis of this disease. Generally, chronic elevated serum glucose causes nonenzymatic glycosylation of the vasculature in the kidneys. Cytokines and other inflammatory markers have also been implicated in activating multiple pathways that contribute to glomerular damage over time. These mechanisms lead to hyaline arteriosclerosis, endothelial damage, and podocyte loss, which increase the glomerular filtration pressure and contribute to loss of proteins in the urine. This is a secondary cause of nephrotic syndrome.

Codes

ICD10CM:
E11.29 – Type 2 diabetes mellitus with other diabetic kidney complication

SNOMEDCT:
127013003  –  Diabetic renal disease

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Diabetic nephropathy is a clinical diagnosis. Long-standing diabetes in the setting of progressive proteinuria or frank nephrotic syndrome supports the diagnosis of diabetic nephropathy. Alternative diagnoses to consider:

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 01/14/2019
Last Updated: 03/01/2019
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Diabetic nephropathy
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Diabetic nephropathy : Fatigue, Albuminuria, Hyperglycemia, Polyuria, Proteinuria, Pallor, Polydipsia, Pedal edema, Polyphagia, BP increased, Weight change
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